Heroin addicts who have used buprenorphine after failing to overcome their addiction using methadone praise the drug, first approved for use in 2002. Buprenorphine is patented by Reckitt Benckiser and prescribed under the name Suboxone as an anti-craving medication that doesn't get users high. "It is the first real innovation in treatment in 40 years," said Phoenix House medical director Terry Horton.

However, after more than two years on the market, relatively few patients are using bupe. Reckitt Benckiser says 5,000 doctors are prescribing the drug, but other experts say the number is half that or less. In New York City, home to 200,000 heroin addicts, records show that 34,000 people were on methadone in 2004, while just 1,000 filled a bupe prescription. "It's depressingly few," said Lloyd Sederer, New York City's deputy executive commissioner for health and mental hygiene.

Addiction experts had hoped that general practitioners would feel comfortable prescribing bupe over methadone, but that has not happened so far. Another problem is that lawmakers drafted poor regulations for the drug, including a 30-patient limit on group practices and a ban -- since revoked -- on bupe being prescribed by methadone clinics. Methadone clinics are still restricted to prescribing one dose of bupe per day, a rule that doesn't apply to other providers.

Critics add that Reckitt, better known for consumer products like Lysol, has been very conservative in marketing the drug. Advocates like Sederer are promoting the drug to health workers and patients at needle-exchange programs, methadone clinics, treatment centers, and other places where heroin addicts congregate. In New York, the goal is to get 60,000 addicts on bupe by 2010. "We're doing all the work for the drug company," Sederer said. "Here you have a couple of psychiatrists launching a marketing campaign!"

Herb Kleber, medical director for the Center on Addiction and Substance Abuse (CASA) at Columbia University, said a poorly designed physician-education curriculum has also hindered acceptance of bupe. "The courses are a disaster," said Kleber, who has been hired by the federal government to redesign the curriculum. Kleber said the courses reinforce stereotypes about addicts as untrustworthy and fails to allow doctors to interact with actual patients.

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